10 January 2013

U.S. Public Health And Safety Dismal

The United States lags behind almost every other developed country in terms of both public health and public safety, according to a major new comparative study of mortality and mobidity (i.e. deaths and impairment from illnesses) in United States and sixteen other developed countries (see also here). Canada, Japan, Australia and most of Western Europe was included in the study.

American levels of public health and public safety are often closer to those of developing countries and third world countries than to those of its developed nation peers.

The key findings of the 378 page study by a panel of experts included the following:Americans Under Age 75 Are Less Healthy Than Their Developed Country Peers

* "Deaths before age 50 accounted for about two-thirds of the difference in life expectancy between males in the United States and their counterparts in 16 other developed countries, and about one-third of the difference for females. . . . American men ranked last in life expectancy among the 17 countries in the study [at 75.6 years], and American women ranked second to last [at 80.7 years]. . . . Americans also had the lowest probability over all of surviving to the age of 50."

* "The United States had the second-highest death rate from the most common form of heart disease, the kind that causes heart attacks, and the second-highest death rate from lung disease, a legacy of high smoking rates in past decades. . . . The report . . . details health indicators for youths where the United States ranks near or at the bottom. There are so many that the list takes up four pages. Chronic diseases, including heart disease, also played a role for people under 50."

* "American adults . . . have the highest diabetes rates." . . . Americans consumed an average of 3,770 calories per day, a higher average than in any other country."

* Americans lose more years of life before age 50 to alcohol and drug abuse than people in any of the other countries." This is despite the fact that Americans are less heavy drinkers. Americans "abuse more prescription and illicit drugs."

* "Car accidents, gun violence and drug overdoses were major contributors to years of life lost by Americans before age 50."

* American "young people have the highest rates of . . . deaths from car crashes . . . Deaths from motor vehicle cashes, non-transportation-related injuries, and violence occur at much higher rates in the United States than in other countries and are a leading cause of death in children, adolescents and young adults."

* "Americans are less likely to wear seat belts and more likely to ride motorcycles without helmets."

* "[S]uicide rates were lower in the United States, [but] firearm suicide rates were six times higher."

* As another report on the study notes: "The United States has about six violent deaths per 100,000 residents. None of the 16 other countries included in the review came anywhere close to that ratio. Finland was closest to the U.S. . . . with slightly more than two violent deaths per 100,000 residents. . . . [H]omicide and suicide together account for about a quarter of the years of life lost for U.S. men compared to those in those peer contries. . . . our risk of death from homicide is seven times higher[.]" Homicide is the second leading cause of death among Americans aded 15-24, the large majority of which involve firearms.

* "The rate of firearm homicides was 20 times higher in the United States than in the other countries, according to the report, which cited a 2011 study of 23 countries. And though suicide rates were lower in the United States, firearm suicide rates were six times higher. Sixty-nine percent of all American homicide deaths in 2007 involved firearms, compared with an average of 26 percent in other countries[.]" * The "United States has the highest rate of firearm ownership among peer contrie - 89 civilizan-owned firearms for every 100 Americans, and the U.S. is home to about 25 to 50 percent of the wold's civilizan-owned firearms[.]"

* "[T]here is little evidence that violent acts occur more frequently in the United States . . . . It's the lethality of those attacks that stands out."

Poor Americans Are Worst Off, But Americans Of All Social Classes Are Worse Off

* The United States "has the highest rates of poverty among the countries studied. . . . In the other countries, more generous social safety nets buffer families from the health consequences of poverty[.]" Child poverty in the United States was particularly high relative to its developed country peers.

*Americans who have not graduated from high school die from diabetes at three times the rate of those with some college[.]"

* The "United States has a highly fragmented health care system, with limited primary care resources and a large uninsured population."

* While low income and minority individuals in the United States are comparatively worst, "even the people most likely to be healthy, like [white] college-educated Americans and those with high incomes," are less health than the peers in other developed countries.

* Immigrants in the United States are generally healthier than native born Americans.

American's Have Grown Less Healthy Only After World War II

* "[T]he pattern of higher rates of disease and shorter lives . . . was responsible for dragging the country to the bottom in terms of life expectancy over the past 30 years. . . as recently as the 1950s, Americans scored better in life expectancy and disease than many of the other countries in the current study. . . . And it’s getting worse.”

In Some Respects The U.S. Does Well

* The U.S. "spends more on health care than any other in the survey."

* The U.S. has among the highest per capita incomes in the developed world (particularly after adjusting for mineral resource driven wealth).

* The has among the highest rates of secondary and higher education completion in the world.

* "Americans are less likely to smoke and may drink less heavily than their counterparts in other countries."

* American health outcomes are better than its peers for people aged 75 or older.

The U.S. Is Showing Progress Or Implementing Reforms On Many Fronts

Progress On Smoking And Room For Progress On Heart Disease and Diabetes

* Greatly reduced smoking rates in the last couple of decades are almost certain to greatly reduce future lung cancer rates, and bans on smoking in public which have just started to take effect in the last few years have also been shown to greatly reduce heart disease deaths.

* Obesity and adult onset diabetes have been recognized as major public health problems, even if the solutions to those problems remain elusive.

Weight loss experts like South Beach Diet author Arthur Agatston, M.D., attribute a significant share of the blame fo the obesity epidemic to widely promoted low-fat, high-carb diets promoted by George McGovern's Senate Committee, the U.S. Department of Agriculture's "food pyramid" and the American Heart Association. This consensus on what went into a healthy diet were based on early empirical research by Dr. Ansel Keys and others that missed key nuances like the importance of fiber and the health distinctions between different kinds of fats, which led to a conventional wisdom about healthy eating that was greatly at odds with the reality of healthy eating.

A more sedentary lifestyle due to increased use of computers and television, and less walkable communities due to suburbanization and the rise of Euclidian zoning have also been important factors on the exercise side of the equation.

There is good reason to believe that major cultural changes based on increased empirical studies of what works in weight reduction and what kind of weight reduction really matters may provide a route to addressing the obseity problem. Long term studies of food consumption by Americans over the past decades have shown that Americans have been quite responsive in changing their diets in response to new widespread understandings about which foods are or are not healthy to eat.

Progress Related To Teen Pregnancy And Fertility Rates For The Poor

* While teen pregnancy rates in the United States are high by international standards, they have fallen greatly and are at all time lows for the United States.

* In the last decade or so, for the first time in more than a century, poor women are having fewer children than affluent women, which should help to reduce the rates of child poverty.

Progress Related To The Health Care System

* The Affordable Health Care Act, aka Obamacare, the key provisions of which take effect in 2014 and is almost certain to actually take effect in light of the 2012 election results and U.S. Supreme Court decisions upholding the constitutionality of some of its key provisions, will dramatically reduce the ranks of the uninsured in the United States and will also make other improvements to the health care delivery system in the United States.

* The quality of U.S. trauma care in hospitals has made significant improvement in recent decades in many metropolitan areas that have developed "trauma center" hospitals, and also a result of improved medical treatment options. For example, "liquid bandages" have greatly improved the ability of medical providers to treat blood loss particularly from internal bleeding.

* Medical treatments for AIDS have become much more effective, and vaccination for HPV which is just beginning has the potential to greatly reduce the incidence of this STD and the cancers it causes over the next several decades.

Progress Related To Homicides

* While homicide rates in the United States are high by international standards, they have fallen dramatically in the last twenty years to near all time lows. Also, some U.S. regions have homicide rates far below the U.S. average, so much of the homicide problem in the U.S. is a product of regional cultures and policies rather than national ones.

Progress Related To Accidental Deaths And Drug Abuse

* U.S. deaths from accidents have fallen to near record lows in almost every category except accidental drug overdoses (often of prescribed or unprescribed prescription drugs like painkiller Oxycontin) and continue to do so. DUI related motor vehicle accident deaths, for example, have fallen greatly.

* Concerted efforts to reduce DUI deaths and deaths in motor vehicle accidents by young drivers are ongoing and showing signs of success.

* The drug overdose problem in the United States is very particularized, is linked to the legal health care delivery system quite intimatedly, and is recent in origin, so it is plausible that a quite narrow solution could solve this major public health problem.

* Rising levels of prescription drug abuse and overdoses have obscured progress in reducing rates of deaths and hospitalizations from illicit drug overdoses.

* American policymakers are slowly but steadily beginning to treat drug abuse more like a public health problem as many of our developed country peers have, and less like a criminal justice issue.

The U.S. Is Slipping Or Making No Progress On Other Fronts

Weak Points In U.S. Health and Health Care Systems

* Obesity rates continue to rise despite widespread public health efforts to address them because no empirically validated, consensus approach to successfully address it has been devised.

* Health care costs continue to rise and remain dramatically greater than those of peer nations despite the fact that our system has worse outcomes for all but the oldest patients. Moreover, where the U.S. has better outcomes (for patients age seventy-five and older), U.S. health care costs are extremely high compared to other developed country peers.

* U.S. mental health care systems have still not recovered from the deinstitutionalization revolution half a century ago. More mentally ill people are incarcerated than are in inpatient mental health care facilities.

Economic Inequality, Business Cycles and Political System Flaws

* The U.S. is making little or no progress in addressing income inequality, poverty, or child poverty. And, marriage rates continue to fall while divorce rates remain high for poor and working class Americans even as marriage remains a healthy institution and divorce rates are falling for the upper middle class. The one bright spot is that the 2012 fiscal cliff legislation has left the United States with the most progressive federal income tax structure that it has had since 1979. But, higher taxation for the affluent was not accompanied by any improvements in the safety net for the less affluent.

* Little progress is being made in developing and implementing ways to address child abuse, child neglect and the poor conditions faced by children in foster care.

* Some of the recent positive trends in U.S. public health and public safety indicators are the product to a great extent of a long term economic boom that continue from about 1983 to 2007 interupted by recessions that were relatively mild in terms of economic pain for most Americans. Since then, we have had the worst recession since the Great Depression and it may be decades but for public health and public safety consequences of this recession manifest themselves and reverse these trends.

* No progress has been made in finding ways to fix a political system that systemically favors the old over the young. Few people even recognize this as an important deep political source for U.S. policy biases in this regard.

Gun Control and Criminal Justice

* Recent developments in Second Amendment law have seriously limited policy efforts to regulate firearms.

* It is not clear if the trend towards reduced incarceration in the United States, which has the highest incarceration rates in the world, will be positive, by reducing poverty and public expenditures on prisons and allowing for more people to contribute economically to U.S. life, or while be negative by fueling increased crime rates.Education

* The academic achievement of American students is only middling by developed world standards and the U.S. is starting to lag within higher education by the critical measure of native born residents who are earning STEM degrees. Arguably, the U.S. is merely par for the course in education, dramatically underdevelops the educational potential of academically strong students from lower and middle income families, and is greatly overcredentialed. The U.S. record of preparing the non-college bound for the workforce is also well below international standards.

* Efforts to include public health through the curriculum of schools are very slight, are frequently ineffectual, and not infrequently promote approaches that recent research has demonstrated to be counterproductive (e.g. home economics classes that teach middle school kids to make Hamburger Helper (R) and other nutritionally poor foods.